Provider Demographics
NPI:1164589891
Name:EVANS, ISHAM HARRISON (M D)
Entity Type:Individual
Prefix:DR
First Name:ISHAM
Middle Name:HARRISON
Last Name:EVANS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 JACKSON AVE E
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3809
Mailing Address - Country:US
Mailing Address - Phone:662-236-5773
Mailing Address - Fax:662-236-5844
Practice Address - Street 1:401 JACKSON AVE E
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3809
Practice Address - Country:US
Practice Address - Phone:662-236-5773
Practice Address - Fax:662-236-5844
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS099632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry